EBSA health investigations remained steady last year, more than half involved mental health parity

EBSA closed 347 health investigations in FY 2017 (compared to 330 in FY 2016), according to the FY 2017 Mental Health Parity and Addiction Equity Act (MHPAEA) Enforcement Fact Sheet. Of these 347 closed investigations, 187 involved plans subject to MHPAEA and were, therefore, reviewed for MHPAEA compliance. The fact sheet also notes that of these 187 investigations where MHPAEA applied, EBSA cited 92 violations for MHPAEA noncompliance.
EBSA enforces Title 1 of ERISA on 2.2 million private employment-based group health plans, which cover 130.8 million participants and beneficiaries. EBSA relies on its 400 investigators to review plans for compliance with ERISA, including the MHPAEA. EBSA also employs 110 benefits advisors who provide participant education and compliance assistance regarding MHPAEA. Benefits advisors also pursue voluntary compliance from plans on behalf of participants and beneficiaries.
Generally, if violations are found by an EBSA investigator, the investigator requires the plan to remove any offending plan provisions and pay any improperly denied benefits. To achieve the greatest impact, Investigators will also seek a global correction, working with the plans’ service providers to find improperly denied claims and correct the problem for other plans as well.

Examples of enforcement actions.

The fact sheet provides six examples of MHPAEA enforcement actions, including removing restrictions on residential treatment, eliminating more restrictive financial requirements, reimbursing participants for excessive copayments, and eliminating overly stringent precertification requirements.
One example involved additional coverage for mental health and substance use disorder treatment. The Los Angeles Regional Office discovered that a plan failed to provide out-of-network coverage for inpatient and outpatient mental health and substance use disorder benefits. Based on the findings of the investigation, a settlement agreement was executed to achieve correction of multiple plan violations, including these MHPAEA violations. As a result of the investigation, 52 mental health and substance use disorder claims were reprocessed and the plan paid $24,152 in previously denied mental health and substance use disorder benefits. The plan also revised its documents to comply with parity requirements.

SOURCE: FY2017 MHPAEA Enforcement Fact Sheet, dol.gov/agencies/ebsa
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